What are your must-do's?

queenjulie, RN · Jul 11, 2011

I can't wait to see the responses to this! As a student, you can be sure I will be printing it out and memorizing it for clinicals! :)

rnlately · Jul 11, 2011

I use a nursing "cheat sheet" which is essentially a grid of flow sheet with the kardex info of the patients in a condensed form. I record lab values that are due/pertinent, special information (ex. don't call MD unless hgb less than 9.0), and any type of dx testing for the next am. Also check the charts and EMAR for new orders/meds in case they are not on the MAR printed at the very beginning of th shift. Also make sure to see the newly admitted pt's first unless one of the other pt's has something critical or potentially critical going on with them (remember ABC's). Assess new admit's pain early in the shift which is essential for working pm shift so as to cut down on unnecessary calls to the MD in the midnight or wee hrs in the morning for something that could have been taken care of before the doctor went to bed.

tokmom, BSN, RN · Jul 11, 2011

Gosh, I don't think I shortcut on anything. It's all important to do it correctly everytime to prevent infections, errors..

One thing that always gets my complete attention and I won't chit chat while doing it, is pulling meds from pyxis and giving them. Before we scanned meds, I would take the MAR into the room with me. Now that we scan, I ask the pt their name and check name band, every single time. I also double check the meds against the screen. I'm totally paranoid, but I have no shortcuts, but have a 0% error rate with a 100% scan rate.

Anytime I make a note on a pt, I check for any labs updates and new meds. It helps keep me on task so I don't fall behind. We are computerized though, so it makes it easy to check all of this while in the room.

LegzRN · Jul 11, 2011

Must dos? Hmm... usually grab a cup of coffee and survey the break room for whats left of the chinese food that administration bought for day shift.

Tait, MSN, RN · Jul 11, 2011

Must dos? Hmm... usually grab a cup of coffee and survey the break room for whats left of the chinese food that administration bought for day shift.

This made me smile. Mostly because I know, from experience, that nights always get the shaft on treats.

Must Do's:

Check charts first thing in the morning.
Start my med pass by 8am.
Double check labs before starting meds/charts.
Round on all my patients with the night nurse first thing and assess pain, comfort, needs, stability.
Check in with my secretary and gauge how good a day she is having!
Give report to my techs.
Pee when I need to!
Focus when pulling meds.
Date and time my IV bags and lines.
Check my IV sites.
Run Vancomycin slow on tiny veined old peeps.
Dilute my medications to protect veins.
Assure my patients the docs will round, but never assume responsibility when they don't do it until 5pm (however I do try and call them and keep my patients posted on if I have seen them on the floor yet or not.)
Keep my pain peeps on a schedule.
Communicate with my charge nurse.
Check on my peers.

The lists go on and on!

Everyday is different, but eventually you get into a rhythm and a pattern. You will notice I didn't mention charting, that is because some days it just has to wait until after your shift if patient priorities are higher. I find that sitting down for 10 minutes at the end and focusing completely on charting can sometimes be a much better idea than stopping and starting lines all day long.

Best of luck!

Tait

proudnurseRN · Jul 11, 2011

I cannot sit to chart until all my physical work has been done.

I have to check the last 2-3 pages of orders before doing anything else... I hate surprise orders at 2am. A couple of weeks ago I was too busy to do this task and found a stat potassium ordered at 1700 that wasn't done... and it was 2300.

I cannot sit and take a break or chit-chat while a co-worker is running around like crazy. One of these days that might change, because it seems some days I'm the only one that feels that way, but I can't stand to see someone stressed out.

chicookie, BSN, RN · Jul 11, 2011

must do:

Don't kill anybody. That includes coworkers, administration and doctors.

Katie5 · Jul 11, 2011

Gosh, I don't think I shortcut on anything. It's all important to do it correctly everytime to prevent infections, errors..
One thing that always gets my complete attention and I won't chit chat while doing it, is pulling meds from pyxis and giving them. Before we scanned meds, I would take the MAR into the room with me. Now that we scan, I ask the pt their name and check name band, every single time. I also double check the meds against the screen. I'm totally paranoid, but I have no shortcuts, but have a 0% error rate with a 100% scan rate.
Anytime I make a note on a pt, I check for any labs updates and new meds. It helps keep me on task so I don't fall behind. We are computerized though, so it makes it easy to check all of this while in the room.

I agree with most of what you wrote but the bolded might be against infection control.

BeachPrincess · Jul 11, 2011

I must have my brain!!! It's a sheet that list all my meds an times to give along with swan numbers, iv med gtts.

I must have each cart in my room stocked!! I cant stand for my patient to code or go south and I have no flushes in my room.

I must have extra linen in my rooms.

NeoPediRN · Jul 11, 2011

Passing a catheter q4h on trached kids.

Blood pressure and HR before any cardiac/bp meds (sounds like a "duh" moment you'd be surprised how many nurses do NOT do this!)

Rotating sat probes q4h (our are notorious for causing burns)

Checking my meds one more time against EMAR before going to a patient's room

Actually counting the narc I'm giving before subtracting it from the sheet

tyvin, BSN, RN · Jul 11, 2011

Always punch in at least a few minutes before the shift starts. I have worked with people who come in right on the dot and then we waste time waiting for them to put their stuff away ect... We're suppose to be giving report and many times these late types are simply oblivious to the fact. I know many places penalize you if you punch in too early but is coming in 5 minutes earlier to stow your gear before punching in asking too much?

As a charge never for any reason ignore the first rounds or counting all your employees.

As a charge make sure the one person you called in to cover a sick call actually came in.

As a nurse passing meds always do the narc count correctly with the correct person in the correct way.

As a nurse doing what ever I'm assigned I must have my equipment belt at all times. It carries a plethora of nursing instruments such as tape, hemostats, second hand piece, BP cuff and monitor, alcohol packets, various size syringes, an assortment of candy, etc...

Don't forget to clean that stethascope with the alcohol wipes from your nurse tool belt. Do I really need to mention the hands ...

When taking an order from a doc either on the phone or in person ALWAYS repeat it back to them for confirmation so there are no mistakes.

If unfamiliar with a med and it's dosages; check. Don't take the docs word for it. An RN should be aware of all drug parameters that cross their path. In many instances it's the last time to catch a mistake and yes you as well as the others who were involved with the order are held liable for any mistakes. Because you are suppose to know!

Last but no least ... realize you can't cure the whole world. That in your tiny little corner of the universe you do make a difference. Be happy with your work and go home happy and fulfilled.